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Published on: February 28, 2025
Prenatal Cannabis Use and Offspring Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders: A
Kelly C Young-Wolff1,2, Kevin Kong1, Stacey E Alexeeff1
1Division of Research, Kaiser Permanente Northern California, Pleasanton, CA.
Insights
Maternal cannabis use during pregnancy did not increase the risk of attention deficit hyperactivity disorder (ADHD) or disruptive behavior disorders (DBD) in offspring. This large study found no association between prenatal cannabis exposure and these neurodevelopmental conditions.
Area of Science:
- Reproductive Health
- Neurodevelopmental Disorders
- Public Health
Background:
- Prenatal cannabis exposure is a growing public health concern due to increasing legalization and use.
- Understanding the impact of maternal cannabis use on offspring neurodevelopment is crucial for clinical guidance and policy.
- Existing research on the association between prenatal cannabis exposure and offspring behavioral outcomes has yielded mixed results.
Purpose of the Study:
- To investigate the association between maternal cannabis use during early pregnancy and the risk of attention deficit hyperactivity disorder (ADHD) in offspring.
- To examine the relationship between prenatal cannabis exposure and disruptive behavior disorders (DBD) in children.
- To analyze the impact of cannabis use frequency and detection method (self-report vs. toxicology) on these associations.
Main Methods:
- A population-based retrospective birth cohort study included 141,570 children born between 2011 and 2018.
- Maternal prenatal cannabis use was assessed via universal screening, self-report, and toxicology testing.
- Cox proportional hazards regression models adjusted for maternal characteristics were used to analyze associations with offspring ADHD and DBD diagnosed by age 11.
Main Results:
- Maternal prenatal cannabis use was not associated with an increased risk of ADHD (aHR: 0.84, 95% CI, 0.70-1.01).
- An inverse association was observed between prenatal cannabis use and DBD (aHR: 0.83, 95% CI, 0.71-0.97), particularly when cannabis use was confirmed by toxicology.
- No significant associations were found when cannabis use was defined by self-report alone or by frequency of use.
Conclusions:
- Maternal cannabis use during early pregnancy is not associated with an increased risk of offspring ADHD.
- The study found no increased risk for DBD, with an inverse association noted when use was verified by toxicology.
- These findings suggest that prenatal cannabis exposure may not pose the neurodevelopmental risks previously feared for ADHD and DBD.
Objective:
To examine whether maternal cannabis use during early pregnancy is associated with offspring attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD).
Methods:
We conducted a population-based retrospective birth cohort study of children (N = 141,570) born between 2011 and 2018 to pregnant individuals (N = 117,130) in Kaiser Permanente Northern California universally screened for any prenatal cannabis use at the entrance to prenatal care (at ∼8-10 wk gestation). Prenatal cannabis use was defined as (1) self-reported use and/or a positive toxicology test, (2) self-reported use, (3) a positive toxicology test, and (4) self-reported use frequency. Cox proportional hazards regression models adjusting for maternal characteristics (sociodemographics, other substance use and substance use disorders, prenatal care initiation, comorbidities) examined associations between prenatal cannabis use and offspring ADHD and DBD diagnosed by age 11 years.
Results:
The sample of pregnant individuals was 27.2% Asian/Pacific Islander, 5.7% Black, 24.5% Hispanic, and 38.8% non-Hispanic White, with a mean (SD) age of 30.9 (5.2) years; 4.6% screened positive for any cannabis use (0.4% daily, 0.5% weekly, 1.1% monthly or less, 2.7% unknown frequency); 3.92% had a positive toxicology test and 1.8% self-reported use; 7.7% of offspring had ADHD and 6.8% had DBD. Maternal prenatal cannabis use was not associated with ADHD (adjusted hazard ratio [aHR]: 0.84, 95% CI, 0.70-1.01), and there was an inverse association with DBD (aHR: 0.83, 95% CI, 0.71-0.97), which remained when cannabis was defined by toxicology testing but not by self-report. Frequency of use was not associated with outcomes.
Conclusion:
Maternal prenatal cannabis use was not associated with an increased risk of offspring ADHD or DBD.
